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Incidental durotomy resulting in a postoperative lumbosacral nerve root with eventration into the adjacent facet joint: illustrative cases – Lumbar Spinal Stenosis

This article from J Neurosurg Case Lessons discusses a rare complication of lumbar decompression surgery, where the nerve root can herniate into an adjacent facet joint, leading to postoperative radiculopathy. The study presents three cases where patients experienced symptoms after surgery, which were eventually attributed to nerve root eventration into the facet joint due to an unrecognized durotomy. Surgical intervention to free the nerve roots from the facet joint resulted in significant improvement in all cases. The article emphasizes the challenges in diagnosing this complication, even with advanced imaging, highlighting the importance of a high index of suspicion and a low threshold for surgical exploration

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

BACKGROUND: Radicular pain after lumbar decompression surgery can result from epidural hematoma/seroma, recurrent disc herniation, incomplete decompression, or other rare complications. A less recognized complication is postoperative nerve root herniation, resulting from an initially unrecognized intraoperative or, more commonly, a spontaneous postoperative durotomy. Rarely, this nerve root herniation can become entrapped within local structures, including the facet joint. The aim of this study…

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J Neurosurg Case Lessons. 2024 Apr 22;7(17):CASE2418. doi: 10.3171/CASE2418. Print 2024 Apr 22. ABSTRACT BACKGROUND: Radicular pain after lumbar decompression surgery can result from epidural hematoma/seroma, recurrent disc herniation, incomplete decompression, or other rare complications. A less recognized complication is postoperative nerve root herniation, resulting from an initially unrecognized intraoperative or, more commonly, a spontaneous,

J Neurosurg Case Lessons. 2024 Apr 22;7(17):CASE2418. doi: 10.3171/CASE2418. Print 2024 Apr 22.

ABSTRACT

BACKGROUND: Radicular pain after lumbar decompression surgery can result from epidural hematoma/seroma, recurrent disc herniation, incomplete decompression, or other rare complications. A less recognized complication is postoperative nerve root herniation, resulting from an initially unrecognized intraoperative or, more commonly, a spontaneous postoperative durotomy. Rarely, this nerve root herniation can become entrapped within local structures, including the facet joint. The aim of this study was to illustrate our experience with three cases of lumbosacral nerve root eventration into an adjacent facet joint and to describe our diagnostic and surgical approach to this rare complication.

OBSERVATIONS: Three patients who had undergone lumbar decompression surgery with or without fusion experienced postoperative radiculopathy. Exploratory revision surgery revealed all three had a durotomy with nerve root eventration into the facet joint. Significant symptom improvement was achieved in all patients following liberation of the neural elements from the facet joints.

LESSONS: Entrapment of herniated nerve roots into the facet joint may be a previously underappreciated complication and remains quite challenging to diagnose even with the highest-quality advanced imaging. Thus, clinicians must have a high index of suspicion to diagnose this issue and a low threshold for surgical exploration.

PMID:38648675 | DOI:10.3171/CASE2418

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Incidental durotomy resulting in a postoperative lumbosacral nerve root with eventration into the adjacent facet joint: illustrative cases

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J Neurosurg Case Lessons. 2024 Apr 22;7(17):CASE2418. doi: 10.3171/CASE2418. Print 2024 Apr 22. ABSTRACT BACKGROUND: Radicular pain after lumbar decompression surgery can result from epidural hematoma/seroma, recurrent disc herniation, incomplete decompression, or other rare complications. A less recognized complication is postoperative nerve root herniation, resulting from an initially unrecognized intraoperative or, more commonly, a spontaneous

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